1. 1 Module 4 Signs and Symptoms

2. 2 Situation Assessment Known information regarding the chemical release Recognition of the event based on signs and symptoms

3. 3 Not All Signs and Symptoms May Appear Immediately Manifestation based on: –dose, –duration, and –route of entry

4. 4 Nerve Agent Exposure

5. 5 Signs and Symptoms: Nerve Agent Vapor Exposure Affects organs directly contacted by agent Affects other organs as agent is absorbed into body systems Signs and symptoms appear in seconds to minutes Peak effects within 15 to 25 minutes after exposure stops

6. 6 Signs and Symptoms: Mild Vapor Exposure Pinpoint pupils (w/ or w/o redness, pain) Dim or blurred vision Runny nose Slight chest tightness Slight difficulty breathing Secretions (tears, nasal fluids, saliva, sweat, phlegm) Nausea and vomiting

7. 7 Signs and Symptoms: Moderate Vapor Exposure Pinpoint pupils (w/ or w/o redness, pain) Dim or blurred vision Excessively runny nose Pronounced chest tightness Plentiful secretions Moderate to severe breathing difficulty Nausea and vomiting Diarrhea General muscle weakness

8. 8 Signs and Symptoms: Severe Vapor Exposure Same as for moderate exposure, plus Loss of consciousness Convulsions Generalized rippling of muscles under skin Flaccid paralysis Cessation of breathing Involuntary urination or defecation

9. 9 Signs and Symptoms: Liquid Nerve Agent on Skin Effects differ from vapor exposure –Different signs and symptoms –Different timing of appearance General rule: the more severe the exposure, the quicker effects appear

10. 10 Signs and Symptoms: Mild Liquid on Skin Exposure Sweating at site of exposure Rippling of muscles under skin at site of exposure Effects appear in 10 min to 18 hrs, depending on dose

11. 11 Signs and Symptoms: Moderate Liquid/Skin Exposure Same as for Mild exposure, plus Nausea, vomiting, and diarrhea Generalized sweating Generalized weakness, tiredness, or ill feeling Effects appear in 10 min to 18 hrs, depending on dose

12. 12 Signs and Symptoms: Severe Liquid on Skin Exposure Same as for Moderate exposure, plus Collapse Loss of consciousness Convulsions Severe respiratory difficulty Flaccid paralysis Cessation of breathing Involuntary urination or defecation Effects appear suddenly in 2-30 min

13. 13 Differential Diagnosis Refers to distinguishing one disease from another when they produce similar signs and symptoms

14. 14 Diseases Producing Symptoms Similar to Nerve Agent Exposure Epilepsy Gastroenteritis Exposure to agricultural insecticides (organophosphates and carbamates) Heat illness Emphysema Stroke Head trauma Drug overdose

15. 15 VESICANT AGENT EXPOSURE

16. 16 Signs and Symptoms by Route of Exposure Agent vapor affects eyes, skin, and airways Agent liquid on skin or eyes –Produces more severe effects than vapor –Does not normally affect airways Large exposures via either route can affect internal body systems

17. 17 Signs and Symptoms of Exposure to Mustard Agent Vapor Agent contacts skin and eyes –Causes surface damage –Absorbed into body Agent is inhaled into respiratory tract –Damages mucous membranes –Absorbed into body

18. 18 Signs and Symptoms of Vapor Exposure on Eyes Mild exposure –Tearing, itching, burning, gritty feeling, sensitivity to light –Effects appear in 4-12 hrs Moderate exposure –Same as for Mild exposure, plus reddening, swelling of lids, moderate pain –Effects appear in 3-6 hrs Severe exposure –Same as for Moderate, plus marked swelling of lids, possible damage to cornea, severe pain –Effects appear in 1-2 hrs

19. 19 Signs and Symptoms of Vapor Exposure on Skin Mild exposure –Reddening of skin with itching, burning, and stinging Severe exposure –Same as for Mild exposure, plus blisters Effects appear in 2-24 hrs

20. 20 Signs and Symptoms of Vapor Exposure on Airways Mild exposure –Runny nose; pain in throat, nostrils, sinus; sneezing; nose bleed; hoarseness; hacking cough –Effects appear in 6-24 hrs Moderate exposure –Same as for Mild exposure, plus, loss of voice, productive cough Severe exposure –Same as for Moderate exposure, plus mild-to-severe breathing difficulty –Effects appear in 2-6 hrs

21. 21 Signs and Symptoms of Vapor Exposure on GI Tract Nausea and vomiting Effects appear a few hrs to 24 hrs after exposure

22. 22 Signs and Symptoms of Liquid Exposure on Skin or Eye Effects similar to those for vapor exposure but more severe and appear sooner –Eyes—tearing, itching, burning, gritty feeling, sensitivity to light, swelling of lids, damage to cornea, pain –Skin—reddening, itching, burning, stinging, blisters Effects most apparent at exposure site

23. 23 Signs and Symptoms of Liquid Exposure on Eyes Effects same as for vapor exposure, but more severe For severe exposure –Symptoms can appear within minutes –Can result in severe damage to cornea, loss of vision, or loss of eye

24. 24 Signs and Symptoms of Liquid Exposure on Skin Effects similar to those for vapor exposure, but more severe –Tissue damage is deeper –Tissue death may occur at exposure site Injury comparable to third-degree burn

25. 25 How Sulfur Mustard Agent Blisters Skin Normal skin Reddened skin Blistered skin

26. 26 Sulfur Mustard Blisters

27. 27 Other Possible Causes of Signs and Symptoms Blister agent signs and symptoms could also apply to: –hay fever –chemical or thermal burns –heavy tear gas exposure –poison ivy, poison oak, and other contact allergies

28. 28 Summary: Pop Quiz Match signs & symptoms on the left with the correct cause on the right Miosis Blisters on skin Breathing difficulty Extreme sore throat Runny nose Hearing loss Rippling muscles Swollen eyelids Nerve Agent Mustard Agent Either Neither

29. 29 Summary: Pop Quiz Answers Miosis—Nerve agent Blisters on skin—Mustard agent Breathing difficulty—Either Extreme sore throat—Mustard agent Runny nose—Nerve agent Hearing loss—Neither Rippling muscles—Nerve agent Swollen eyelids—Mustard agent